Endoscopic endonasal transsphenoidal hypophysectomy: two hand versus four hand technique: our experience

Area of Science:

• Neurosurgery
• Otolaryngology
• Endoscopic Surgery

Background:

• The operating microscope was the traditional visualization tool for transsphenoidal surgery.
• Early endoscopic approaches combined rigid endoscopes with operating microscopes.
• Surgical techniques advanced to exclusively utilize rigid endoscopes via nasal passages.

Purpose of the Study:

• To evaluate the evolution and outcomes of endoscopic transsphenoidal surgery for pituitary adenomas.
• To compare early and later endoscopic techniques in terms of visualization and patient recovery.

Main Methods:

• Retrospective analysis of 96 patients with pituitary adenomas treated over ten years.
• Review of surgical approaches, including sublabial transseptal and purely endonasal methods.
• Assessment of postoperative outcomes, focusing on nasal airway patency and patient comfort.

Main Results:

• Endoscopic visualization replaced the operating microscope in transsphenoidal surgery.
• Purely endonasal endoscopic approaches were developed, progressing from single to dual nostril techniques.
• Postoperative endonasal endoscopic surgery resulted in unobstructed nasal airways and minimal discomfort.
• Over half of the patients experienced overnight hospitalization.

Conclusions:

• Endoscopic transsphenoidal surgery offers significant advantages over traditional microscope-assisted procedures.
• The refinement of endonasal endoscopic techniques has led to improved patient recovery and reduced hospital stays.
• Endoscopic pituitary adenoma surgery is a safe and effective treatment with favorable postoperative outcomes.